1.  PLACE OF DEATH
County:  Breckinridge
Vot. Pol.:  5305
Inc Town:  
City:  
No.  
St.  
Ward:  1st  
Registration District No.:  
Primary Registration District No:  
File No.  5628
Registered No:  7  
2.  FULL NAME:  Lizzie M. Hardin
PERSONAL AND STATICAL PARTICULARS
3.  SEX:  Female
4.  COLOR OR RACE:  White
5.  SINGLE, MARRIED, WIDOWED, OR DIVORCED:  Married
6.  DATE OF BIRTH:  June 6, 1874
7.  AGE  (yr. mo. da) (If less than 1 day, hours or min?):  36 yrs, 9 mos, 5 days
8.  OCCUPATION (a.) Trade, profession or particular kind of work:  Housewife
(b.)  General nature of industry business or establishment which employed:  Home & children
9.  BIRTHPLACE:  Kentucky
10.  NAME OF FATHER:  John H. McGavock (Dec'd)
11.  BIRTHPLACE OF FATHER:  Virginia
12.  MAIDEN NAME OF MOTHER:  Elizabeth Skillman
13.  BIRTHPLACE OF MOTHER:  Kentucky
14.  THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE
(Informant)  Elizabeth Skillman
(Address)  Cloverport, Ky
15.  Filed  Mch 11, 1911
REGISTAR:  J. C. Nolte
MEDICAL CERTIFICATE OF DEATH
16.  DATE OF DEATH:  March 11, 1911
17.  I HEREBY CERTIFY, That I attended deceased from (date):  March 4, 1911 to March 11, 1911
That I last saw her alive on (date):  March 11, 1911
And that death occurred on the date stated above at (time AM/PM):  1 am
THE CAUSE OF DEATH was as follows:  Pneumonia

(Duration)   Years:            Months:            Days:  8
Contributory:  

(Duration)   Years:            Months:  1          Days:  1
Signed (M.D.):  F. L. Lightfoot
Date:  March 11, 1911
Address:  Cloverport, KY
18.  LENGTH OF RESIDENCE (For Hospitals, Institutions, Transients, or Recent Residents)
At place of death (yr, mo, da.):  
In the State (yr, mo, da):  
Where was disease contracted,  if not at place of death?  
Former or usual residence:  
19.  PLACE OF BURIAL OR REMOVAL:  Cloverport, Ky
DATE OF BURIAL:  March 12, 1911
20.  UNDERTAKER:  M. HAMMAN
ADDRESS:  Cloverport, Ky